When is a tummy ache not just a tummy ache?

When is a
tummy ache not just a
tummy ache?
A GUIDE TO MANAGING
STOMACH PAIN AND OTHER
GASTROINTESTINAL CONDITIONS
STOMACH PAIN
WHAT
IS IT?
CHECKLIST
TIPS
WHEN
TO CALL
DIARRHEA
HOW WE
TREAT IT
MORE ON
TREATMENT
WHAT
IS IT?
WHEN
TO CALL
HOW WE
TREAT IT
CONSTIPATION
MORE ON
TREATMENT
WHAT IS IT? &
WHEN TO CALL
HOW WE
TREAT IT
GET TING HELP
RELATED
CONDITIONS
LOCATIONS
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AN APPT
What is stomach pain?
It is 2 a.m. and your child has a tummy ache. Was it caused
by something she ate? Is she experiencing cramping, gas or
constipation? This is a common childhood scenario, and the
reality is every child will have an upset stomach at some point.
Rest assured, while stomach pain can happen for any number
of reasons, the discomfort is usually short-term, and children
continue to maintain their overall good health.
What causes stomachaches?
Our gastrointestinal tract is a complicated system of nerves
and muscles that pushes the food we eat through the digestive
process. But some children’s nerves are very sensitive. Even
normal intestinal activities upset their nerves, causing pain.
In some cases, a stomachache is caused by a very specific
problem such as ulcers, heartburn or constipation. In other
children, the cause may not be so clear.
An infection caused by a virus, bacteria, stress or fatigue
may make the intestinal nerves more sensitive and trigger pain.
In some cases, the problem may be genetic, which means it’s
a condition that “runs in the family,” so other family members
may have a similar history of the problem.
Did you know 10 to 15
percent of all school-aged
children report recurrent
tummy aches and pains?
These pains can disrupt a child’s
everyday life and cause them
to lose interest in activities they
normally enjoy.
STOMACH PAIN
WHAT
IS IT?
CHECKLIST
TIPS
WHEN
TO CALL
DIARRHEA
HOW WE
TREAT IT
MORE ON
TREATMENT
WHAT
IS IT?
WHEN
TO CALL
HOW WE
TREAT IT
CONSTIPATION
MORE ON
TREATMENT
WHAT IS IT? &
WHEN TO CALL
HOW WE
TREAT IT
GET TING HELP
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Tummy ache checklist
If your child is experiencing abdominal
pain and able to describe the discomfort,
ask her the following questions:
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For infants and toddlers
who cannot verbalize their
discomfort, here are some signs
your child has a tummy ache:
• increased fussiness
• poor eating
• pulling her legs up toward the belly
STOMACH PAIN
WHAT
IS IT?
CHECKLIST
TIPS
WHEN
TO CALL
DIARRHEA
HOW WE
TREAT IT
MORE ON
TREATMENT
WHAT
IS IT?
WHEN
TO CALL
HOW WE
TREAT IT
CONSTIPATION
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TREATMENT
WHAT IS IT? &
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Tummy ache tips
Helpful tummy ache tips to cure a common stomachache
Most of the time, home remedies will alleviate or eliminate a
common tummy ache. Here are some tips to help reduce your
child’s discomfort caused by a stomachache:
DOs
DON’Ts
• Have your child relax quietly
to see if the abdominal pain
goes away.
Do not give your child foods
or drinks that are irritating to
the stomach including:
• Offer sips of water or other
clear fluids.
• caffeine
• Suggest that your child try
to pass stool.
• citrus
• Avoid solid foods for a few
hours. Then try small amounts
of mild foods such as rice,
applesauce or crackers.
• fried or greasy foods
• carbonated beverages
• dairy products
• high-fat foods
If your child’s pain
is getting worse, or
the pain lasts longer
than 24 hours, call
your pediatrician
and make an
appointment.
• tomato products
DO NOT give aspirin, ibuprofen (Advil®), acetaminophen
(Tylenol®) or similar medicines without first asking your
child’s health care provider.
STOMACH PAIN
WHAT
IS IT?
CHECKLIST
TIPS
WHEN
TO CALL
DIARRHEA
HOW WE
TREAT IT
MORE ON
TREATMENT
WHAT
IS IT?
WHEN
TO CALL
HOW WE
TREAT IT
CONSTIPATION
MORE ON
TREATMENT
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WHEN TO CALL
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When should you call the doctor about
stomach pain?
For mild stomach pains, you
can typically employ home care
remedies and wait for your child to
get better. Contact your child’s pediatrician
when:
• stomach pain lasts more than a week,
even if it comes and goes
• stomach pain is getting more severe
and frequent, or if your child is
nauseous and vomiting with the pain
• your child experiences a burning
sensation during urination
• your child has diarrhea for more than
2 days
• your child has been vomiting for
more than 12 hours
You should seek medical help
immediately if your child: • is younger than 3 months and has
diarrhea or vomiting
• is unable to pass stool, especially
if the child is also vomiting
• is vomiting blood or has blood in
the stool (especially if the blood is
maroon or dark, tarry black)
• has sudden, sharp abdominal pain
• has a rigid, hard belly
• has had a recent injury to the
abdomen
• is having trouble breathing
• is currently being treated for cancer
• your child has a fever over 100.4
degrees Fahrenheit
• your child has had a poor appetite for
more than 2 days
• your child is experiencing
unexplained weight loss
STOMACH PAIN
WHAT
IS IT?
CHECKLIST
TIPS
WHEN
TO CALL
DIARRHEA
HOW WE
TREAT IT
MORE ON
TREATMENT
WHAT
IS IT?
WHEN
TO CALL
HOW WE
TREAT IT
CONSTIPATION
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TREATMENT
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How Boston
Children’s Hospital
treats stomach pain
Whether your child is experiencing
frequent or chronic stomach pain
or upset, or ongoing bouts of
diarrhea or constipation, Boston
Children’s Hospital’s Division of
Gastroenterology, Hepatology and
Nutrition is here to help.
Ranked the #1 pediatric
gastroenterology division in the nation
by U.S. News & World Report 2015–
16, our expertly trained team works
with you and your child to find the
relief she needs. Most stomachaches
can be capably managed by a
pediatrician. In the cases where a
referral is necessary, we proudly
provide individualized treatment plans
and access to more specialized care
than any other hospital.
Click here
for a list of
Boston Children’s
locations near you.
STOMACH PAIN
WHAT
IS IT?
CHECKLIST
TIPS
WHEN
TO CALL
DIARRHEA
HOW WE
TREAT IT
MORE ON
TREATMENT
WHAT
IS IT?
WHEN
TO CALL
HOW WE
TREAT IT
CONSTIPATION
MORE ON
TREATMENT
WHAT IS IT? &
WHEN TO CALL
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How Boston Children’s Hospital
treats stomach pain | continued
To best understand the root of your child’s stomach
pain, a member of our clinical staff will take a
careful history of how and when your child’s pain
started, the type of pain your child is experiencing,
and ask how it has progressed over time. We may perform blood, urine and stool tests to rule
out specific medical conditions associated with
recurrent pain. We will also ask if your child has any
history of food intolerances.
We only perform more in-depth tests, such as
x-rays or endoscopy, if your child’s medical history,
exam or lab tests raise further questions. Once we have determined a proper diagnosis, the
care team will create a treatment plan that’s right for
your child and family. With the right treatment, most
children with stomach pain continue to grow well
and gain weight.
In some cases, abdominal pain might affect a child’s
ability to attend school or perform their normal
activities. In such cases, we can provide additional
support through our multidisciplinary team, which
includes dietitians and psychologists.
To make an appointment or to speak with a
member of our clinician staff, contact the Division
of Gastroenterology, Hepatology and Nutrition at
Boston Children’s: 617-355-6058.
STOMACH PAIN
WHAT
IS IT?
CHECKLIST
TIPS
WHEN
TO CALL
DIARRHEA
HOW WE
TREAT IT
MORE ON
TREATMENT
WHAT
IS IT?
WHEN
TO CALL
HOW WE
TREAT IT
CONSTIPATION
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TREATMENT
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WHEN TO CALL
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What is diarrhea?
Diarrhea is often an uncomfortable
part of the tummy ache equation.
Diarrhea is watery stool, an increased
frequency of bowel movement,
or both. In most cases, diarrhea in
children lasts no more than a few
days and goes away on its own.
These short-term (or acute) cases
of diarrhea are usually related to
bacterial or viral infections.
In other cases, diarrhea may last
for weeks at a time; this is called
chronic diarrhea. Chronic diarrhea
may also be caused by infections,
such as giardia, but is more likely
to be caused by a chronic medical
condition, such as irritable bowel
syndrome, or an inflammatory
condition such as ulcerative
colitis, Crohn’s disease or celiac
disease. Chronic diarrhea
in children may
indicate a larger
health problem.
If your child has
diarrhea for more
than a few days,
consult your
pediatrician.
STOMACH PAIN
WHAT
IS IT?
CHECKLIST
TIPS
WHEN
TO CALL
DIARRHEA
HOW WE
TREAT IT
MORE ON
TREATMENT
WHAT
IS IT?
WHEN
TO CALL
HOW WE
TREAT IT
CONSTIPATION
MORE ON
TREATMENT
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When should you call the
doctor about diarrhea?
For mild diarrhea, you can typically use
home care remedies and wait for your
child to get better.
If your newborn (under 3 months old) has
diarrhea, call your pediatrician immediately.
Also, contact your child’s physician if your child has:
• blood, mucus or puss in the stool
• more than 8 stools in 8 hours
• vomiting that continues for more than 12 hours
• fever and diarrhea lasting more than 2 to 3 days
• stomach pain or abdominal cramping
• diarrhea that develops within 1 week of travel
outside of the United States or after a camping trip
(the diarrhea may be due to bacteria or parasites
that require treatment)
If diarrhea persists, contact your
child’s pediatrician. If your
pediatrician recommends an
appointment with a gastroenterology physician, please call us at
617-355-6058.
• weight loss
• significant drop in activity level (e.g., not sitting up
at all or not looking around)
Severe and/or chronic diarrhea may indicate
a serious disease, and it is important to
consult your child’s health care provider if the
symptoms persist or affect daily activities.
Click here for a list of
Boston Children’s
locations near you.
STOMACH PAIN
WHAT
IS IT?
CHECKLIST
TIPS
WHEN
TO CALL
DIARRHEA
HOW WE
TREAT IT
MORE ON
TREATMENT
WHAT
IS IT?
WHEN
TO CALL
HOW WE
TREAT IT
CONSTIPATION
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TREATMENT
WHAT IS IT? &
WHEN TO CALL
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How Boston Children’s
Hospital treats diarrhea
At Boston Children’s Hospital, our expert
team of physicians and nursing staff is
dedicated to caring for and finding the best
treatment options for your child.
The first step in the treatment of diarrhea
typically begins with replacing lost fluids.
To replace the body fluids lost due to
diarrhea, children should drink fluids liberally.
If they are dehydrated, a glucose-electrolyte
solution (for example, Pedialyte® or Infalyte®)
should be given to help the body absorb
fluid more easily. These fluids have the right
balance of water, sugar and salts, and some
are available as ice pops.
If your child’s diarrhea is
getting worse, or the
accompanying pain lasts
longer than 24 hours, call
your pediatrician and make
an appointment.
STOMACH PAIN
WHAT
IS IT?
CHECKLIST
TIPS
WHEN
TO CALL
DIARRHEA
HOW WE
TREAT IT
MORE ON
TREATMENT
WHAT
IS IT?
WHEN
TO CALL
HOW WE
TREAT IT
CONSTIPATION
MORE ON
TREATMENT
WHAT IS IT? &
WHEN TO CALL
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How Boston Children’s Hospital
treats diarrhea | continued
A common result of diarrhea is dehydration.
Seek medical help immediately if your child
shows signs of dehydration.
Signs of dehydration include:
• dry and sticky mouth
• no urine for six hours
• no tears when crying
• sunken eyes
Additional hydration considerations for
treating diarrhea include:
• Avoid juice or soda because these drinks may
make diarrhea worse. • Too much plain water at any age can be
dangerous. • Do not give plain water to infants. • If you are bottle-feeding or breastfeeding your
child, continue to do so.
If a bacterial infection is identified as a cause,
antibiotics may also be prescribed.
For more information, contact Boston
Children’s Division of Gastroenterology,
Hepatology and Nutrition at 617-355-6058.
STOMACH PAIN
WHAT
IS IT?
CHECKLIST
TIPS
WHEN
TO CALL
DIARRHEA
HOW WE
TREAT IT
MORE ON
TREATMENT
WHAT
IS IT?
WHEN
TO CALL
HOW WE
TREAT IT
CONSTIPATION
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TREATMENT
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What is constipation?
Constipation in children is defined as:
• a decrease in frequency of bowel movements,
compared to a child’s usual pattern (some health
care providers define constipation as fewer than
3 bowel movements per week)
What are the types
of constipation in
children?
• the passage of hard, oftentimes large-caliber, dry
bowel movements
Constipation is typically
described as being either
organic or functional.
• bowel movements that are difficult or painful to push out
Contact your child’s health care provider if you have any
questions or concerns about your child’s bowel habits or
patterns or if constipation persists.
Functional constipation
means there is no
identifiable cause.
Functional constipation is
the most common form of
constipation, and while it is
a concern, typically there
is not a serious medical
condition associated with it. We recommend talking to your child’s health care provider if:
• Episodes of constipation last longer than 2 weeks.
• Your child’s discomfort prevents them from participating in
normal activities.
• Normal pushing is not enough to expel a stool.
• Liquid or soft stool leaks out of the anus.
• Small, painful tears appear in the skin around the anus.
Organic constipation
is caused by a diagnosed
medical condition,
like colon disease
or a neurological
problem.
• Hemorrhoids develop.
• Abdominal pain, fever or vomiting occur.
STOMACH PAIN
WHAT
IS IT?
CHECKLIST
TIPS
WHEN
TO CALL
DIARRHEA
HOW WE
TREAT IT
MORE ON
TREATMENT
WHAT
IS IT?
WHEN
TO CALL
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CONSTIPATION
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How Boston Children’s Hospital
treats constipation
FACT Constipation results
in 2.5 million health care
provider visits every year.
To best understand the cause of your child’s constipation, a clinician
from the Division of Gastroenterology, Hepatology and Nutrition will
assess how serious your child’s constipation is by asking if your child:
• has hard or small stools that are difficult or painful to pass
• consistently skips days without having normal bowel movements
• has uncharacteristically large stools
• has stomach pain, poor appetite, crankiness and/or bleeding from the anus
In most cases, there is no need for testing prior to treatment for
constipation in children. However, depending on the severity of the
problem, your doctor may order x-rays or other tests to properly
diagnose the source of the constipation.
Once the root and severity of your child’s constipation have been
determined, a treatment plan will be designed based on your child’s age
and personality. For some, constipation can be corrected by changes
in diet, like increasing their intake of water, fiber or fresh fruit. Other
children may need medications like laxatives or stool softeners to help
them go. FACT Almost 5 percent of
all pediatrician visits are
in some way related to
constipation, and at least 25
percent of visits to pediatric
gastroenterology specialists
are due to problems with
constipation.
In rare cases, children may need to have an excessive build-up of
stool “flushed” from their colon. This usually is done with laxatives,
suppositories or enemas if needed.
For more information on constipation or to speak with a
member of Boston Children’s Division of Gastroenterology,
Hepatology and Nutrition, please call 617-355-6058.
STOMACH PAIN
WHAT
IS IT?
CHECKLIST
TIPS
WHEN
TO CALL
DIARRHEA
HOW WE
TREAT IT
MORE ON
TREATMENT
WHAT
IS IT?
WHEN
TO CALL
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CONSTIPATION
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Related conditions
Allergic Colitis
A cow milk allergy.
Celiac Disease
A lifelong intolerance to gluten—a
protein found in wheat, barley, rye
and also in oats that have been
contaminated with gluten from other
products.
Childhood Obesity
When a child is significantly
overweight. Obesity can increase
a child’s risk for serious and
chronic medical problems, such as
constipation, type 2 diabetes, high
blood pressure (hypertension) and
others.
Crohn’s Disease
A form of inflammatory bowel
disease (IBD) in which one or more
parts of your child’s intestinal tract
become inflamed.
Encopresis
Fecal soiling or accidental bowel
movements.
Eosinophilic Esophagitis (EE)
An allergic reaction that causes
inflammation and damage to the
esophagus, the muscular tube that
connects mouth to stomach.
Eosinophilic Gastrointestinal
Disorders (EGIDs)
Rare conditions that can occur when
there are high levels of eosinophils
in one or more parts of the digestive
system. Eosinophils are a type of
white blood cell that is involved in
allergic reactions. Hepatitis C
A liver disease affecting 3 percent
of all children worldwide.
Food Allergy
An abnormal response to a certain
food.
Inflammatory Bowel Disease
A chronic condition where parts of
the intestinal tract become inflamed.
Functional and/or Intractable
Abdominal Pain
Abdominal pain often accompanied
by diarrhea, constipation or both,
which can be related to irritable
bowel syndrome (IBS).
Jaundice
A condition that makes a baby’s skin
and the white part of the eyes look
yellow.
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Short Bowel Syndrome (SBS)
A serious condition where a child
does not have enough small
intestine, which may lead to
dehydration and malnutrition.
Ulcerative Colitis
A form of inflammatory bowel
disease (IBD) where one or more
parts of the intestinal tract become
inflamed.
Gastroesophageal Reflux (GER)
Causes the return of acidic stomach
juices, or food and fluids, from
the stomach back up into the
esophagus.
Hepatitis B Virus (HBV)
Irritation and swelling (inflammation)
of the liver due to infection with the
hepatitis B virus (HBV).
STOMACH PAIN
WHAT
IS IT?
Hyperbilirubinemia
and Jaundice
A condition in which there is too
much bilirubin in your baby’s blood.
Stomach and Duodenal Ulcers
An open sore or lesion usually found
on the skin or mucous membrane.
An ulcer in the lining of the stomach
or duodenum is referred to as a
peptic ulcer.
DIARRHEA
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IS IT?
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Locations
Pediatric care close to home
As a leading pediatric hospital, Boston Children’s is committed to providing expert and
compassionate care to our patients. We have been advancing medicine and improving child
health for more than 140 years and proudly have several satellite locations throughout our
community of care, including:
Boston Children’s Hospital
300 Longwood Avenue
Boston, MA 02115
Click here
for a list of
Boston Children’s
locations near you.
North of Boston
Boston Children’s
at Lexington
482 Bedford Street
Lexington, MA 02420
STOMACH PAIN
TIPS
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Boston Children’s
Physicians Norwood
Draper Building, 1st Floor
800 Washington Street
Norwood, MA 02062
Boston Children’s
Physicians Weymouth
Stetson Medical Building
Suite 218
541 Main Street
Weymouth, MA 02190
DIARRHEA
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TREATMENT
West of Boston
Boston Children’s
at Waltham
9 Hope Avenue
Waltham, MA 02453
Boston Children’s
Physicians Worcester
21 Eastern Avenue
Worcester, MA 01605
Boston Children’s
Physicians
North Dartmouth
500 Faunce Corner Road
North Dartmouth,
MA 02747
Winchester Family
Medical Center
500 Salem Street
Route 62
Wilmington, MA 01887
CHECKLIST
Boston Children’s
Physicians Brockton
Medical Office Building
Suite 220E
830 Oak Street
Brockton, MA 02301
Milford Regional
Medical Center
3rd Floor
14 Prospect Street
Milford, MA 01757
Boston Children’s
at Peabody
10 Centennial Drive
Peabody, MA 01960
WHAT
IS IT?
South of Boston
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IS IT?
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When a
tummy ache
is more than
just a tummy ache,
call 617-355-6058 or visit
bostonchildrens.org/GI
Click here
for a list of
Boston Children’s
locations near you.
THIS BOOKLET
IS AVAILABLE AT
BOSTONCHILDRENS.ORG/
TUMMYACHE
STOMACH PAIN
WHAT
IS IT?
CHECKLIST
TIPS
WHEN
TO CALL
DIARRHEA
HOW WE
TREAT IT
MORE ON
TREATMENT
WHAT
IS IT?
WHEN
TO CALL
HOW WE
TREAT IT
CONSTIPATION
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